Kidney disease parameters, metabolic goal achievement, and arterial stiffness risk in Chinese adult people with type 2 diabetes

J Diabetes. 2022 May;14(5):345-355. doi: 10.1111/1753-0407.13269. Epub 2022 May 5.

Authors

Chen Xu¹, Li Li¹, Juan Shi^{2

3}, Bangqun Ji⁴, Qidong Zheng⁵, Yufan Wang⁶, Tingyu Ke⁷, Li Li⁸, Dong Zhao⁹, Yuancheng Dai¹⁰, Fengmei Xu¹¹, Ying Peng^{2

3}, Yifei Zhang^{2

3}, Qijuan Dong¹, Weiqing Wang^{2

3}

Affiliations

¹ Department of Endocrinology and Metabolism, People's Hospital of Zhengzhou Affiliated Henan University of Chinese Medicine, Zhengzhou, China.
² Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P.R. China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Endocrinology, Xingyi People's Hospital, Xingyi, China.
⁵ Department of Internal medicine, The Second People's Hospital of Yuhuan, Yuhuan, China.
⁶ Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
⁸ Department of Endocrinology, Ningbo First Hospital, Ningbo, China.
⁹ Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
¹⁰ Department of Internal medicine of traditional Chinese medicine, Sheyang Diabetes Hospital, Yancheng, China.
¹¹ Department of Endocrinology and Metabolism, Hebi Coal (Group), LTD, General Hospital, Hebi, China.

Abstract
in English, Chinese

Background: To investigate the arterial stiffness (AS) risk within urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) categories and the joint effect between kidney disease parameters and metabolic goal achievement on AS risk in adult people with type 2 diabetes (T2D).

Methods: A total of 27 439 Chinese participants with T2D from 10 National Metabolic Management Centers (MMC) were categorized into four albuminuria/decreased eGFR groups. The criteria for decreased eGFR and AS were eGFR <90 ml/min/1.73 m² and brachial-ankle pulse wave velocity value >the 75th percentile (1770.0 cm/s). Three metabolic goals were defined as glycated hemoglobin <7%, BP <130/80 mmHg, andlow-density lipoprotein cholesterol <2.6 mmol/L.

Results: After full adjustment, odds ratios (ORs) for AS were highest for albuminuria and decreased eGFR (2.23 [1.98-2.52]) and were higher for albuminuria and normal eGFR (1.52 [1.39-1.67]) than for those with nonalbuminuria and decreased eGFR (1.17 [1.04-1.32]). Both UACR and eGFR in the subgroup or overall population independently correlated with AS risk. The achievement of ≥2 metabolic goals counteracted the association between albuminuria and AS risk (OR: 0.93; 95% CI: 0.80-1.07; p = .311). When the metabolic goals added up to ≥2 for patients with decreased eGFR, they showed significantly lower AS risk (OR: 0.65; 95% CI: 0.56-0.74; p < .001).

Conclusions: Both higher UACR and lower eGFR are determinants of AS risk, with UACR more strongly related to AS than eGFR in adults with T2D. The correlation between albuminuria/decreased eGFR and AS was modified by the achievement of multiple metabolic elements.

背景: 探讨成人2型糖尿病(T2D)患者尿白蛋白/肌酐(UACR)和估计肾小球滤过率(eGFR)两类指标对动脉硬化(AS)风险的影响, 以及肾脏疾病和代谢目标实现程度对AS风险的联合影响。方法: 将来自10个国家代谢管理中心(MMC)的27439名T2D受试者分为4个白蛋白尿/eGFR降低组。以eGFR<90ml/min/1.73m² 和臂-踝脉搏波传导速度>第75百分位数(1770.0 cm/s)为标准。确定3个代谢目标:HbA1c<7%, BP<130/80 mmHg, LDL-C < 2.6 mmol/L。结果: 完全校正后, 蛋白尿和eGFR降低的AS的OR值最高(2.23[1.98~2.52]), 蛋白尿和eGFR正常的AS的OR值(1.52[1.39~1.67])高于无蛋白尿且eGFR降低的AS(1.17[1.04~1.32])。亚组或总体人群中的UACR和eGFR均与AS风险独立相关。如果实现了≥2代谢目标则抵消了蛋白尿与AS风险之间的关联(OR:0.93 95%CI:0.80~1.07, P=0.311)。当eGFR降低患者的代谢目标加起来≥2时, AS风险显著降低(OR:0.65, 95%CI:0.56~0.74, P<0.001)。结论: 高UACR和低eGFR都是AS的危险因素, 在成人T2D患者中, UACR与AS的相关性比eGFR更强。蛋白尿/降低的eGFR与AS之间的相关性被多种代谢目标的实现所修正。.

Keywords: 2型糖尿病; brachial-ankle pulse wave velocity (baPWV); cardiovascular disease (CVD); estimated glomerular filtration rate (eGFR); metabolic goal; type 2 diabetes; urinary albumin-to-creatinine ratio (UACR); 代谢目标; 估计肾小球滤过率(eGFR); 尿白蛋白/肌酐比值(UACR); 心血管疾病; 臂-踝脉搏波传导速度(BaPWV).

© 2022 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.

MeSH terms

Adult
Albuminuria / epidemiology
Albuminuria / etiology
Ankle Brachial Index
China / epidemiology
Creatinine
Diabetes Mellitus, Type 2* / epidemiology
Glomerular Filtration Rate
Goals
Humans
Kidney Diseases*
Pulse Wave Analysis
Vascular Stiffness*

Substances

Creatinine